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4th yr- CMS- Neuroanatomy > Common Neurological Disorders > Flashcards

Common Neurological Disorders Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

List some common neurological problems

A
  1. Epilepsy
  2. Multiple sclerosis
  3. Parkinson’s disease
  4. Sciatica
  5. Cerebral palsy
  6. Down’s syndrome
  7. Stroke and TIA
  8. Dementia
  9. Retinal degeneration
  10. Neoplasm
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2
Q

What can the impact of neurological diseases be

A
  1. Abnormal sensory function
  2. And normal motor function
  3. Abnormal co ordination
  4. Abnormal organic function
  5. Abnormal cognitions
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3
Q

Is carpal tunnel syndrome more common in men or women

A

Women

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4
Q

What is the carpal tunnel

A

It is where the median nerve passes in the wrist

It is formed by a ring of bones and tough tendon

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5
Q

What is the significance of the Median nerve

A

It innervated the thumb, finger, middle finger and half the ring finger closest to the thumb

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6
Q

What happens in carpal tunnel syndrome

A

Swelling can occur in the carpal tunnel leading to the compression of the median nerve

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7
Q

When might the carpal tunnel be swollen

A
  1. Pregnancy
  2. Obesity
  3. Structural damage to the wrist
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8
Q

What are some of the symptoms of carpal tunnel syndrome

A
  1. Pain
  2. Altered association including numbness or burning
  3. Decreased motor power and weak grip
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9
Q

How do we manage carpal tunnel syndrome

A
  1. Rest- wrist splints
  2. Exercises
  3. Drugs
  4. Surgical decompression
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10
Q

What is sciatica

A

Symptoms arising from the sciatic nerve

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11
Q

What is the sciatic nerve

A

The largest nerve arising from the spinal cord

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12
Q

What are the symptoms of sciatica

A

Mild back ache (minor nerve compression)
Severe pain shooting down the leg which may be accompanied with numbness and loss of motor power (major nerve compression)

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13
Q

What is sciatica commonly caused by

A

Compression of one or more of the 6-6 nerve roots arising from the distal end of the spinal cord
Most commonly due to prolapsed intervertebral disk (slip disk)

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14
Q

How do we manage sciatica

A

Rest

Surgical decompression

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15
Q

What is a seizure

A

Occurs when there is temporary abnormal electrical activity in a group of brain cells that may spread to involve other parts of the brain

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16
Q

What is another term for seizure

A

Convulsion

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17
Q

What is a seizure characterised by

A
  1. Range of clinical features

2. Duration of a few seconds or minutes

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18
Q

What can seizures be broadly divided into

A
  1. Epilepsy

2. Other seizures

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19
Q

What is epilepsy

A

A group of disorders with many different causes all of which are characterised by a tendency to have recurring unprovoked seizures

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20
Q

Name the different types of epilepsy

A
  1. Active epilepsy
  2. Refractory epilepsy
  3. Status epilepticus
  4. Other
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21
Q

Define active epilepsy

A

Occurrence of an epileptic seizure in the last 2 years
Or
Where a patient is taking medication to prevent further epileptic seizures

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22
Q

Define refractory epilepsy

A

Inadequate control of seizures despite optimal treatment

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23
Q

What is status epilepticus

A

It is rare but serious condition where epileptic seizures continue either constant or repeatedly over a period of 30 mins or more

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24
Q

When are we all susceptible to seizures

A

If the brain is subjected to certain stressful situations eg

  1. Fever
  2. Hypoglycaemia
  3. Withdrawal of alcohol in alcohol dependency
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25
Q

How common is active epilepsy

A

1 in 200 people have it in the uk

350,000 people

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26
Q

How common is refractory epilepsy

A

1 in 700 people in the uk

100,000 people

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27
Q

How is epilepsy classified

A
  1. Partial epileptic seizures

2. Generalised epileptic seizures

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28
Q

What are partial epileptic seizures

A

When Abnormal electrical activity is restricted to a focal area of the brain

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29
Q

What can partial epileptic seizures be further classified into

A
  1. Temporal lobes epilepsy

2. Occipital love epilepsy

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30
Q

What can temporal love epilepsy result in

A

Abnormalities of taste or smell, psychic disturbances including deja vu

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31
Q

What can occipital love epilepsy result in

A

Abnormal visual perceptions such as balls of light or coloured patterns

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32
Q

What can happen to partial epileptic seizures if they are untreated

A

Around half of partial seizures subsequently become generalised

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33
Q

How do some partial seizures become generalised

A

The abnormal electrical activity spread from a focal area to involve both cerebral hemispheres

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34
Q

What will happen if a partial seizure doesn’t become generalised

A

Patient will either have:

  1. No impairment of consciousness
  2. Impaired consciousness but not loss
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35
Q

What do generalised epileptic seizures reflect

A

Reflect abnormal electrical activity throughout the cerebral hemispheres

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36
Q

What can generalised epileptic seizures develop from

A
  1. Partial seizures
    Or
  2. A Discrete event without a focal onset
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37
Q

Name the most common form of generalised seizures

A

Grand mal epilepsy

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38
Q

What is Grand Mal Epilepsy also known as

A

Tonic clonic epilepsy or seizures

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39
Q

List the defined stages of tonic clonics

A
  1. Prodrome
  2. Aura
  3. Tonic phase
  4. Clonic phase
  5. Post-ictal phase
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40
Q

Describe the prodrome stage of tonic clonic

A

It precedes the main symptoms where it is characterised by typically vague features such as unease, irritability or non specific malaise that may last hours or days

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41
Q

What is the aura stage of tonic clonics

A

Can occur in patients who experience a partial seizure that subsequently becomes generalised
The symptoms depend on the anatomical site of the partial seizure and may include disturbances of one or more sensory modalities

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42
Q

What is the tonic phase of tonic clonics

A

Lasts only a few seconds usually and is characterised by unconsciousness, inability to maintain a normal posture which usually results in the patient falling
Absence of breathing as the best walk muscles have gone into spasms and patient may cry of grunt as it happens
Increased thoracic pressure can result in deoxygenated blood pooling in facial tissues
Tongue busting
Drooling g
Urinalysis and faecal incontinence may occur

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43
Q

Name the first clear indication of tonic clonic seizures

A

The tonic phase

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44
Q

Which phase follows the tonic phase

A

Clonic phase

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45
Q

What is the clonic phase

A

Last seconds or minutes and is characterised by generalised rhythmic muscular movements which may be quite violent and the tongue may be bitten
Patient remind unconscious

46
Q

What does ictus mean

A

Means seizures but is usually reserved for the description of the period after a tonic clonic seizure

47
Q

Describe the post-ictal phase

A

Last several minutes to hours and reflects a period of recovery
Initially the patient is unconscious or confused but full consciousness has usually been regained in 15-60 mins

48
Q

What can the post-ictal phase be associated with

A

Generalised muscular aches, a sore tongue and headache, strong desire to sleep

49
Q

What can epilepsy be caused by

A
  1. Genetic and congenital causes

2. Acquired diseased

50
Q

List some acquired Illnesses that may lead to epilepsy

A
  1. Cerebrovascular disease
  2. Cerebral neoplasms
  3. Alcohol related brain damage
  4. Post traumatic brain damage
51
Q

When is a diagnosis of epilepsy made

A

When a patient has 2 or more unprovoked seizures

52
Q

What is the impact of a diagnosis of epilepsy

A
  1. Driving affected
  2. Employment and earning potential
  3. Child may have learning difficulties
    4 memory loss
53
Q

How can driving be affected if a patient has epilepsy

A

Patient must refrain from driving for one year from the date of the attack

54
Q

What employment options are restricted for a patient with epilepsy

A
  1. Control of a vehicle or aircraft
  2. Positions in the police, armed forces or fire brigade
  3. Merchant seaman
55
Q

What are the aims of epilepsy management

A
  1. Prevent seizures without causing unacceptable side effects due to medication or other interventions
  2. Optimise the patients quality of life
56
Q

What to drugs for epilepsy management aim to do

A

Drugs aims to raise the seizure threshold and so prevent seizure initiation

57
Q

What does management of epilepsy include

A
  1. Identification and where possible, correction or underlying conditions that promote seizure initiation
  2. Avoidance of situations that precipitate seizures
  3. Active intervention to reduce seizure frequency
58
Q

List some medication used to manage epilepsy

A
  1. Carbamazepine
  2. Sodium valproate
  3. Phenytoin
  4. Lamotrigine
  5. Gabapentin
59
Q

What influences our decision when choosing which drug to prescribe to manage epilepsy

A
  1. Seizure type
  2. Age
  3. Learning difficulties
  4. Complexity of the situation
60
Q

What is the standardised mortality rate for epilepsy

A

2-3

2-3 times greater risk of dying compared to matched individuals without epilepsy

61
Q

What is the death risk for a patient with refractory epilepsy

A

1 in 200 per year

62
Q

What can the outcome following an initial seizure be

A

Can be predicted to some degree:

  1. Patients with underlying structural abnormalities are least likely to remit
  2. Many patient s without an obvious cause for their epilepsy have a better change of ultimately coming off mediation
  3. Patient s who have had 2 unprovoked seizures 65% will expedite further seizures within 4 years
63
Q

What is multiple sclerosis

A

Is an inflammatory demyelinating disease of the CNS that is disseminated in time and space

64
Q

What does dissemination in time mean

A

That clinics attacks occur at different points in time

65
Q

What does dissemination in space mean

A

Means that lesions occur at different neuro anatomical sites

66
Q

How common is multiple sclerosis

A

1 in 750 (90,000 people)

67
Q

Is multiple sclerosis more common in men or women

A

Women are affected twice as much

68
Q

What is the pathology of MS

A
  1. MS plaque

2. Infections in the pathogenesis if MS

69
Q

Where and why does multiple sclerosis plaque form

A

Forms in the CNS as a consequence of inappropriate lymphocyte induced and macrophage mediated inflammation

70
Q

What does macrophage mediated inflammation result in

A

Results in demyelination of t the nerve axons

This impairs nerve conduction

71
Q

What is MS thought to arise due to

A

A combination of genetic predisposition and an environmental trigger such as viral infections

72
Q

Describe the clinical features of MS

A

They are highly variable and change with time depending on where the plaque is and if sensory or motor nerves are affected

73
Q

List some common symptoms of MS

A
  1. Weakness
  2. Optic neuritis
  3. Paraesthesia (numbness of tingling)
  4. Diplopia (double vision)
  5. Trouble passing urine (micturation disturbances)
  6. Vertigo
  7. Fatigue
  8. Mood disturbances
74
Q

List some sensory symptoms of MS

A
  1. Dysaesthesias including off sensations

2. Neuropathic pain

75
Q

List some motor symptoms of MS

A
  1. Spasticity

2. Ataxia of the limbs

76
Q

What is spasticity

A

Spinal cord lesions result in limb stiffness
Flexor spasms
Cramps
Clonus

77
Q

When is a diagnosis of MS made

A

Diagnosis not made until a patient has experienced clinical attacks at more than one neuroanatomical site at different times

78
Q

A diagnosis of MS is made after…

A

One clinical attack if an MRI scan of the brain and spinal cord after the first attack identify new plaque

79
Q

Why is an accurate diagnosis of MS important

A

To prevent:

  1. A patient being given an inappropriate MS label
  2. Delayed diagnosis
80
Q

What are the aims of MS management

A
  1. Communication of accurate information
  2. Optimise support
  3. Optimise physical impairment and function
  4. Optimise control of pain
  5. Limit progression
81
Q

How can we carry out symptomatic treatment of chronic problems

A
  1. Spasticity
  2. Oxybutynin
  3. Tricyclic antidepressants
  4. Systemic corticosteroids
  5. Interferon
  6. Cannabinoids
82
Q

Talk through the different subtypes of MS

A
  1. Initially illness is categorised by a cute attacks
  2. Primary progressive MS
  3. Benign MS
83
Q

What is primary progressive MS

A

it is characterised by a lack of remissions and rapid progression of impairment and disability

84
Q

What is benign MS

A

Characterised by a lack of significant impairment and disability 10 years after diagnosis

85
Q

What is death in MS patients usually due to

A

An unrelated cause

Suicide is 2-7 times more common in patients with MS

86
Q

What is Parkinsonism

A

It is a descriptive term for a clinical state with the main clinical features of:

  1. Bradykinesia
  2. Rigidity
  3. Resting tremor
87
Q

What is Bradykinesua

A

Slow movement

88
Q

What can Parkinsonism caused by

A
  1. Parkinson’s disease
  2. Anti- psychotic disease
  3. Head injury
  4. Recreational drugs
  5. Cerebral atherosclerosis
  6. Carbon monoxide poisoning
89
Q

What is Parkinson’s disease

A

A common neurodegenerative disorder categorised by degeneration of dopamine producing cells in the substantia nigra which results in bradykinesia, rigidity etc

90
Q

In whom is Parkinson’s most common in

A

Middle and later life

91
Q

What can Parkinson’s disease be caused by

A
  1. Dopamine in heath
  2. Genetic factors
  3. Environmental factors
92
Q

Where is dopamine made

A

In the substantia nigra (a small area in the midbrain)

93
Q

What is the significance of dopamine

A

It is a neurotransmitter essential to the normal working of motor pathways in the midbrain and in particular the function of the corpus striatum

94
Q

What is the significance of the corpus striatum

A

It receives information about the position and movement of the body from several different parts of the brain

95
Q

What happens to dopamine production as you get older

A

Falls after age if 35

96
Q

What happens as dopamine levels fall

A

The substantia nigra starts to degenerate (also due to finished Lewy bodies)

97
Q

What are Lewy bodies

A

They are abnormal aggregates of protein inside the dying nerve cells

98
Q

What are the clinical features of Parkinson’s disease

A
  1. One side of the body is affected more than the other

2. Only one side of the body may be affected

99
Q

What is bradykinesia characterised by

A

Finished performance of repot ice movements undertaken at a pace determined by the patient

100
Q

Do all Parkinson’s patients have a tremor

A

No

101
Q

Describe the classic form of tremor in Parkinson’s patients

A

A pill rolling tremor as though the patient is trying to roll an object between the thumb and first finger when the arms are at redt

102
Q

List some other features of Parkinson’s disease

A
  1. Loss of postural reflexes
  2. Changes in facial expression
  3. Changes in speech
  4. Altered position
  5. Changes to walk (gait)
  6. Dementia
  7. Depression.
  8. Burning mouth syndrome
103
Q

What are the aims of Parkinson’s disease management

A
  1. Communication of accurate information
  2. Optimise support
  3. Optimise psychical impairments and unctions
  4. Limit progression
104
Q

What are the principles of Parkinson’s disease management

A
  1. Accurate communication of information
  2. Support mechanisms
  3. Drug treatment
  4. Surgery
  5. Emergency therapies
105
Q

What drugs can we use to treat / manage Parkinson’s

A
  1. Levodopa
  2. Dopamine agonists
  3. MAOIs and COMTs
  4. Anti-muscarinic drugs
  5. Anti depressants and anti psychotic agents
106
Q

What is levodopa

A

A pro drug that is decarboxylated to dopamine by surging neurones

107
Q

Name the main alternative to levodopa

A

Dopamine agonists

108
Q

What to MAOIs do

A

Reduce catabolism of dopamine in the CNS

109
Q

What do COMTs do

A

They reduce the catabolism of levodopa in the peripheral circulation

110
Q

What drugs can be used to control tremors and rigidity

A

Anti muscarinic drugs

111
Q

What are the problems with anti muscarinic drugs

A

Adverse drug reactions common and include:
Urinary frequency
Blurring of vision
Xerostomia

4th yr- CMS- Neuroanatomy (4 decks)

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